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The impact of euploid blastocyst morphology and maternal age on pregnancy and neonatal outcomes in natural cycle frozen embryo transfers

  • Assisted Reproduction Technologies
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Abstract

Purpose

To evaluate whether morphology impacts the pregnancy and neonatal outcomes of euploid blastocysts, and whether maternal age still affects outcomes when top-graded, euploid blastocysts are used.

Methods

This retrospective cohort study included all natural-cycle frozen embryo transfers (NC-FET) using an autologous, euploid blastocyst from June 2016 to June 2020 (n = 610). There were five groups based on embryo grade: AA, AB, BA, BB, and “any C”. For analysis of only AA-graded embryos, there were three maternal age groups: < 35, 35–39, and 40 + years. The main outcomes measured were clinical pregnancy and live birth rates, while the secondary outcomes included neonatal outcomes such as gestational age at delivery and birthweight. Multivariable logistic regression models were performed to adjust for confounders.

Results

Euploid blastocysts with poorer morphology had lower odds of pregnancy and live birth; specifically, embryos with inner cell mass (ICM) graded as “C” had statistically significant decreased odds of pregnancy (aOR 0.33, p = 0.04) and live birth (aOR 0.32, p = 0.03) compared with ICM grade “A”. The differences in pregnancy rate between trophectoderm grades were not statistically significant. Even in cycles that transferred a top-graded (AA) euploid embryo, maternal age at transfer was independently associated with outcomes. Embryo grade and maternal age, however, did not significantly impact neonatal outcomes such as prematurity and birthweight.

Conclusion

The morphology of euploid blastocysts and maternal age at NC-FET both independently impact pregnancy outcomes. Neonatal outcomes were similar across embryo morphology and maternal age groups, suggesting that lower morphology euploid embryos not be discounted as viable options for transfer.

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Acknowledgements

The authors would like to thank all participants and hospitals that supported the collection of these data. The use of REDCap was supported by Stanford CTSA award number UL1 TR001085 from the National Center for Research Resources (NCRR) within the National Institutes of Health (NIH).

Funding

National Center for Research Resources,UL1 TR001085

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University School of Medicine, 1195 W Fremont Avenue, Sunnyvale, Stanford, CA, 94087, USA

    Wendy Y. Zhang

  2. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA

    Jasmyn K. Johal

  3. Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Rebecca M. Gardner

  4. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA

    Brindha Bavan & Amin A. Milki

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  1. Wendy Y. Zhang
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  5. Amin A. Milki
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Contributions

W.Y.Z., J.K.J, B.B, and A.A.M. contributed substantially to study design, supervision of study protocol and interpretation of data; W.Y.Z., J.K.J., and B.B. were responsible for data collection; W.Y.Z. and R.M.G. were responsible for data analysis. The first draft of the manuscript was written by W.Y.Z. All co-authors revised the manuscript and approved the final version.

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Correspondence to Wendy Y. Zhang.

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Zhang, W.Y., Johal, J.K., Gardner, R.M. et al. The impact of euploid blastocyst morphology and maternal age on pregnancy and neonatal outcomes in natural cycle frozen embryo transfers. J Assist Reprod Genet 39, 647–654 (2022). https://doi.org/10.1007/s10815-022-02423-1

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  • DOI: https://doi.org/10.1007/s10815-022-02423-1

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